Anodyne, is a term applied to medicines which have a tendency to assuage pain. This desirable purpose may be attained in three different ways: 1. By pare-gorics, or such remedies as are calculated to ease, pain ; 2. By soporifics, which relieve the patient by causing artificial sleep; and 3. By narcotics, or such as stupify, by their action on the nervous system.
This division, though sanctioned by general authority, is very imperfect ; and we shall attempt to explain the subject in a manner. perhaps, more consonant with just principles of animal economy—not from the result, but from the cause by which a proper application of anodynes induces certain changes. in the human body. In order to give a distinct view of the subject, we shall arrange them under three-classes; namely,
I. Such remedies as tend either to remove the offending cause, or prevent the part affected from receiving a sensible and painful impression, viz. in consequence of the amputation of a limb ; the drawing of a tooth; the burning of parts either by the cautery, or by means of a red-hot iron the application of the tourniquet, a tight ligature, compresses, etc. To this class also belong opiates, and other stupifying medicines, administered for the suspension of pain ; but which may be justly termed, "poison sous' of the sensitive faculty." However liberally others may explain the effects of opium on the organs of the mind, we cannot avoid observing, that its operation on the sensorium commune is always attended with violence, and that so powerful a medicine ought not to be intrusted to the hands of those who are but little acquainted with its nature. Nay, we are of opinion, that even medical men cannot be too careful in its exhibition; but far from wishing to deprecate the use of this invaluable drug, which cannot, in the present state of medical science, be excluded from the list of medicinal substances, we shall here venture to suggest a few ideas respedting the propriety, and greater safety, of its external use.
In very painful wounds, excruciating rhuematism, contradtions, and paralytic affections arising from frequent spasms and strictures, the external use of opium is both safe and beneficial, especially if combined with antispasmodic and emollient remedies, such as camphor, lint-seed oil, marsh-mallows, etc. These alone are frequently sufficient to relieve distressing pain, without the assistance of anodynes properly so called; as the latter generally determine the circulation of blood towards the head, and occasion giddiness, stupor, and a relaxation of the nerves. With the above additions, however, opium may be advantageously employed in the form of baths, fomentations, ointments, cataplasms, and particularly in clysters.—(See the article Abdomen, p. 5. laudanion.)
When the pain is in the interior organs, and its seat cannot be precisely ascertained, or when it arises from causes which neither the patient nor physician can discover, we would prefer the following anodyne liniment, a timely application of which has frequently procured immediate relief: take one ounce of the dried leaves of the common henbane, or four ounces of the green plant, and half a pint of sweet olive oil, digest them near a fire for a few days, then express the leaves through a coarse piece of linen, filter the decoction, and preserve, it in a vessel closely stopped. This preparation, if applied warm, or rubbed into painful parts, has, according to our own experience, proved of singular efficacy.
II. Those remedies which are calculated to change, suppress, or evacuate the material cause of pain, and are therefore the most rational, though, unfortunately, not always within the reach of the medical practitioner. Thus, if the intestinal canal be obstructed, or the stomach clogged with acrid matter that cannot fail to produce violent colics, and other disorders, the prin-cipal aim will be to evacuate it by purgatives, or emetics, and thereby not only cure the complaint, but, at the same time, save the patient's life, which, by means of opiates, given either by the mouth or clyster, without such previous evacuations, would be exposed to imminent danger. Hence we are induced to express our opinion decidedly in favour of those who, from a conviction of the great im-portance of the trust reposed in them, seriously hesitate to employ anodynes, so long as there is a possibility of dispensing with such precarious remedies. But, in cases where the. morbid matter cannot be expelled, a skilful practitioner will endeavour, at least, to deprive it of its activity, or to neutralize it, while in the human body. In this manner, pains arising from acrimonious humours are relieved by drinking bland, diluent, and saccharine liquors; from intestinal worms (though resisting every ve-mifuge), by remedies which destroy them before they are carried off by the feces ; from. a pleurisy, by such means as resolve the stagnant fluids, and promote their circulation through the constricted capillary vessels; from stones in the bladder, if they be too large for expulsion, by the use of lime-water, which tends to blunt their edges, etc. These illustrations, however, might be accompanied with a variety of practical hints and precautions, if we did not intend to reserve such observations, till we have occasion to treat of the different acute and painful diseases, under their respective heads.
III. The last class of anodynes comprehends all those which, by exciting impressions and repre-sentations of a different kind, either counteract or .subdue the pain. These are generally resorted to, when neither the affected organs can be locally relieved, the material cause removed, nor the senses stupified by narcotics. Hence physicians are frequently obliged to employ such expedients as may suppress the partial affection, by exciting feelings of a different nature, and perhaps to a more interne degree than those occasioned by the original complaint. These remedies, however, require equal ingenuity and precaution. Thus, for instance, . violent head-ach, toothach, pains of the breast, etc. may be alleviated by blisters, or cata-ms made of onions, garlic, mustard-seed with Vinegar, horse-radish, and similar stimulants; rheumatic and gouty affections, by early friction with flannel, which, for many reasons, is preferable to a flesh-brush. All these applications, nevertheless, ought to be maturely considered, previous to their use, with respect to the place, strength, and duration, of the stimulus.
To this class may also be referred, diversions of the mind ; inclinations and passions artificially excited, in order to direct the attention of the patient to a different object: such expedients are frequently of excellent service, especially in chronic diseases, and to inveterate hypochondriacs. In a similar manner, terror and anger sometimes instantaneously suppress the painful sensations of gouty and rheumatic patients. Thus, the pleasures of conversation, a country-life, theatres, music, dancing, hunting, and similar amusements, are often more effectual anodynes than wine, brandy, or laudanum : the former agreeably cozen and delude the mind ; the latter al-wavs, sooner or later, aggravate the complaint.
Having given this concise view of the subject, we shall add only a few general observations relative to the manner of determining, whether, and when a patient may with safety resort to anodynes ; because, in this place, we cannot enter into particulars, which it would become necessary to repeat, when treating of those substances themselves.
If a person be suddenly seized with violent pains, the cause or source of which cannot be clearly ascertained, it will be of the first consequence to inquire, whether the patient be at the same time subject to febrile heat, accompanied by an unusual determination of blood towards the head, and a strong, full pulse. In such case, it the pain should not abate on the friction of the parts affected, or on plunging the legs in warm water, it would be proper to take a few ounces of blood from the arm or foot. In many instances of acute pain, however, the pulse is considerably depressed, and the circulation of the fluids in general so lan-guid, that the extremities appear rather pale and cold : yet, under these circumstances also, it may frequently become necessary to bleed the patient without delay, in order to restore an uniform action of the vessels ; a point to be determined by the judicious practitioner. From whatever cause an internal or deep-seated pain may arise, it will always be useful to allow the patient considerable portions of diluent drink, such as luke-warm water mixed with a fourth part of milk, or dococtions of barley, blanched oats, rice, etc.; to administer emollient clysters, consisting of six parts of warm water, two of oil, and one of soft sugar; to wrap the suffering part in soft flannel, or, if it can bear the application of heat, to cover the whole with a common poultice, made of the crumb of bread boiled in miik, with the addition of a little sweet oil; to place the patient, if his peculiar situation and circumstances admit of tins practice, in a tepid bath, of a temperature not exceeding 98° of Fahren-heitj and, lastly, if none of these expedients should afford the desired relief, to resort to opium, or laudanum, as the last resource : one grain of the former, or twenty drops of the latter, with a proper quantity of diluent beverage, is generally a sufficient dose, to persons accustomed to its use. But let us here observe, that even in very desperate paroxysms of pain, there is no necessity of giving an indiscriminate preference to opium, till every other method has been previously tried: thus, for instance, the most excruciating head and tooth-ach have often been suddenly dispelled, by applying horse-radish in fresh shavings, or bruised gar-lick, between two fine pieces of muslin, to the bend of both arms, or the hams.
Another simple remedy of equal efficacy, in periodical head-achs, especially in the morning, is a thin piece of fresh lemon-peel freed from the soft fibrous part, and placed on each of the temples, before, the volatile oil be evaporated. These external applications are perfectly safe; for, as their action is confined to the part which they stimulate, they occasion a degree of irritation different from the original complaint, and thus produce a cessation of pain. In the last-mentioned case, we would also recommend the timely application of a few leeches, either to the temples, or rather to the lateral part of the neck, behind the ears, where the effect is almost instantaneous.
Lastly, opium may be called an almost divine remedy, when judi-ciously administered, in gangrenes, after painful amputations, fractures of bones, and, in short, every operation attended with spasms and great prostration of strength 3 but especially in diseases of the eyes, such as the cataract, or gutta serena